Shocked

By John Read: For Complete Post, Click Here…

With evidence for efficacy so thin, and the stakes so high, why is ‘electroshock’ therapy still a mainstay of psychiatry?

ngd- Oh, that’s easy. In the ’70s, a psychiatrist told me he could do 4 ECT treatments in an hour at $150 each. In today’s dollars, that’s $1,016.81 per treatment, or $4,067.24 an hour.

His first human subject was a 39-year-old engineer from Milan, whom the police found wandering around a Rome train station in a confused state. When the first electric shock failed to produce the desired convulsion, Cerletti and his assistant discussed whether to administer a more powerful shock. Cerletti reported:

All at once, the patient, who evidently had been following our conversation, said clearly and solemnly, without his usual gibberish: ‘Not another one! It’s deadly!’

Cerletti proceeded anyway, in the first of the millions of instances that were to follow, and which continue today, of people being given this treatment despite clearly stating they don’t want it. After another, larger electric shock, which did produce a convulsion, the engineer couldn’t recall being shocked; the first of millions of instances of the short-term memory loss caused by this treatment.

Meanwhile, researchers were documenting harm. In 1946, a review called ‘The Brain Changes Associated with Electrical Shock Treatment’ in the Lancet reported extensive haemorrhaging in multiple parts of the brain. Although not willing to conclude that the changes were all ECT-related, the reviewer cited the autopsy findings of a 57-year-old man who had died 90 minutes after his 13th shock: ‘In the frontal and temporal lobes were several small areas of devastation, entirely devoid of ganglion cells … Diffuse degeneration of the nerve cells in the cortex was present.’

A review of the first 20 years of autopsies concluded: ‘damage to the brain, sometimes reversible but often irreversible, occurred in the course of electric shock treatments’. As early as 1956, a ‘controlled study’ of people over 65 had established that ECT accelerates senile dementia. As one early commentator pointed out: ‘given the extraordinarily sensitive electrochemical nature of the human brain, it is not difficult to realise the gross overkill of ECT … Electrical damage and destruction in some degree cannot be avoided.’

The idea that ECT causes brain damage was so obvious to the early proponents that they incorporated it into an explanation for how ECT worked. In 1941, the American physician Walter Freeman, best-known for championing lobotomies, wrote of ECT:

The greater the damage, the more likely the remission of psychotic symptoms … Maybe it will be shown that a mentally ill patient can think more clearly and more constructively with less brain in actual operation.

Freeman’s paper was entitled ‘Brain Damaging Therapeutics’.

Another American psychiatrist explained:

There have to be organic changes … for the cure to take place … I think that it may be true that these people have for the time being at any rate more intelligence than they can handle and that the reduction in intelligence is an important factor in the curative process.

The idea that brain damage can be good seems bizarre to me. Nevertheless, variations and extensions on the theme persist in the 21st century. A study in Scotland in 2012 found that ECT reduces the ‘functional connectivity’ of the brain. Instead of cautioning against ECT because of this damage, the authors claimed that this was evidence to support the theory that the brains of depressed people have ‘hyperconnectivity’ and that ECT corrects this. Some psychiatrists in the Netherlands are even arguing that ECT can, and should, be used to target and erase painful memories.

As I learned in that New York hospital all those years ago, almost everyone experiences some combination of confusion, headaches, nausea and aching muscles immediately after an ECT. This typically wears off within an hour. However, most also experience some memory gaps, usually for the period immediately prior to the treatment. Some lose life memories from months or years before the treatment (‘retrograde amnesia’) and/or have difficulty retaining new information (‘anterograde amnesia’). The Royal College of Psychiatrists (2020) informs the public that:

A small number of patients report gaps in their memory about events in their life that happened before they had ECT. This tends to affect memories of events that occurred during, or shortly before, the depression started. Sometimes these memories return fully or partially, but sometimes these gaps can be permanent.
Sadly, the ECT community hasn’t been sufficiently concerned about long-term damage to establish just how many suffer permanent memory losses. But it is not ‘a small number’.

One review identified four studies of memory loss lasting at least six months and described by patients as ‘persistent or permanent’. They found a range of 29 to 55 per cent, and a weighted average of 38 per cent. The most rigorous study to date was conducted in 2007 by the ECT proponent Harold Sackeim, professor of psychiatry and radiology at Columbia University in New York. Six months after ECT, retrograde amnesia, overall, was much worse than pre-ECT levels. Importantly, the degree of impairment was related to the number of ECTs received. Women and older people were disproportionately impaired. The memory loss was also greater among those who received bilateral ECT (where the electrodes are placed on either side of the head) rather than unilateral ECT (where they are both placed on the same side, thereby protecting half of the brain). Our recent review placed persistent or permanent gaps in life memories, including of weddings and birthdays, somewhere between 12 and 55 per cent.

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